Search

Background: This study aimed to determine the appropriate target intraocular pressure (IOP) for patients newly diagnosed with exfoliation glaucoma. Research design and methods: The study followed a prospective cohort of newly diagnosed exfoliation patients for three years. The target IOP was defined using three methods to measure visual field deterioration, mean deviation (MD), visual field index (VFI), and guided progression analysis (GPA). Results: Over the three years, the mean deviation (MD) values declined by an average of −3.84 (±2.61) dB, while the visual field index (VFI) values dropped by an average of 9.66 (±6.25) %. The untreated IOP at inclusion was 32.52 ± 5.54 mmHg. At the end of the study (due to treatment), it was 17.94 ± 1.82 mmHg, resulting in a reduction of 14.58 mmHg (45% reduction). Based on the MD and VFI methods, the target IOP for the whole cohort was around 14–15 mmHg, while the target IOP based on GPA was around 15 mmHg. For advanced glaucoma cases, the target IOP was around 13 mmHg. Conclusions: The study concludes that the traditional reported IOP reduction of 20% and/or IOP 18–20 mmHg may not be sufficient for patients newly diagnosed with exfoliation glaucoma. Instead, the study recommends a target IOP of 14–15 mmHg for these patients. Clinical Trial Registration: The study was registered in the website with the number NCT06237764. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine whether including genetics as a risk factor for progression will improve the accuracy of the models used in newly diagnosed exfoliation glaucoma patients. Methods: This was a prospective cohort study. This study included only patients who were newly diagnosed with exfoliation glaucoma and received treatment upon inclusion. Blood samples were taken from all patients at inclusion to test for the single nucleotide polymorphisms (SNPs) LOXL-1 rs2165241 and rs1048661. Results: This study found that the frequency of SNPs, as well as intraocular pressure (IOP), mean deviation (MD), and visual field index (VFI) values at diagnosis, were significant predictors of visual field deterioration (p ≤ 0.001). This study showed that interaction terms, including SNPs, were highly significant (p ≤ 0.001). Furthermore, logistic regression analysis also showed highly significant results for interaction terms when SNPs were included (p ≤ 0.001). Finally, the area under the curve (AUC) analysis showed an increased value of around 10–20% when SNPs were included. Conclusions: Adding genetic factors to the well-known clinical risk factors can increase the accuracy of models for predicting visual field deterioration in exfoliation glaucoma patients. However, further studies are needed to investigate the role of other genes in this process. [ABSTRACT FROM AUTHOR]

Background: Exfoliative glaucoma (XFG) is a subtype of open-angle glaucoma characterized by distinctive extracellular fibrils and a yet unknown pathogenesis potentially involving immune-related factors. The aim of this exploratory study was to identify biomarkers for XFG using data from autoimmunity profiling performed on blood samples from a Scandinavian cohort of patients. Methods: Autoantibody screening was analyzed against 258 different protein fragments in blood samples taken from 30 patients diagnosed with XFG and 30 healthy donors. The 258 protein fragments were selected based on a preliminary study performed on 3072 randomly selected antigens and antigens associated with the eye. The "limma" package was used to perform moderated t-tests on the proteomic data to identify differentially expressed reactivity between the groups. Results: Multiple associated genes were highlighted as possible biomarker candidates including FUT2, CDH5, and the LOX family genes. Using seven variables, our binary logistic regression model was able to classify the cases from the controls with an AUC of 0.85, and our reduced model using only one variable corresponding to the FUT2 gene provided an AUC of 0.75, based on LOOCV. Furthermore, over-representation gene analysis was performed to identify pathways that were associated with antigens differentially bound to self-antibodies. This highlighted the enrichment of pathways related to collagen fibril formation and the regulatory molecules mir-3176 and mir-876-5p. Conclusions: This study suggests several potential biomarkers that may be useful in developing further models of the pathology of XFG. In particular, CDH5, FUT2, and the LOX family seem to have a relationship which merits additional exploration. [ABSTRACT FROM AUTHOR]

Purpose: Exfoliation glaucoma is a common and aggressive type of glaucoma with high prevalence in Scandinavia. The aim of this study was to elucidate whether the allele frequencies of two single nucleotide polymorphisms (SNPs) located in LOXL1 were associated with the progression of exfoliation glaucoma in Swedish patients. Methods: In this non‐randomised cohort study, we enrolled patients with exfoliation glaucoma, and they performed at least five reliable visual field tests. Blood samples were collected, and genotyping was performed using competitive allele‐specific PCR genotyping. Glaucoma progression was evaluated using the guided glaucoma progression analysis (GPA), mean deviation (MD) difference and rate of progression (ROP). In addition, associations between allele frequencies and glaucoma progression were tested using logistic regression for GPA and linear regression for MD and ROP. Results: We enrolled a total of 130 patients in the study. The general genetic model showed statistical significance for LOXL1_rs2165241 (p = 8 × 10−7, Fisher's exact test) and LOXL1_rs1048661 (p = 2 × 10−6, Fisher's exact test). Regression analyses using an additive genetic model showed significant values for LOXL1_rs2165241SNP in relation to GPA, MD and ROP as outcomes (p = 1.8 × 10−4, 4 × 10−2, 6 × 10−4) and for LOXL1_rs1048661 SNP in relation to GPA, MD and ROP (p = 7 × 10−5, 8 × 10−3, 2 × 10−4). Conclusions: This was the first study to show an association of the SNPs LOXL1_rs2165241 and LOXL1_rs1048661 with the progression of exfoliation glaucoma. Further large‐scale studies are required to verify these findings. [ABSTRACT FROM AUTHOR]

Purpose: Selective laser trabeculoplasty (SLT) is a first‐line intervention for glaucoma, with the aim to reduce the intraocular pressure (IOP). Topical non‐steroidal anti‐inflammatory drugs (NSAIDs) are sometimes prescribed after SLT. However, it has been proposed that such treatment may either increase or reduce SLT efficacy. The purpose of this study was to investigate this further. Methods: The study was a retrospective chart review, including 192 eyes of 192 patients, half of which received a course of NSAID eyedrops after SLT. Absolute and relative IOP reduction 3–12 weeks after SLT was compared. Furthermore, subgroup analyses, a multiple linear regression analysis, and a Kaplan–Meier survival analysis regarding time to treatment escalation were performed. Results: The mean absolute IOP reduction was 4.3 ± 3.4 mmHg in the NSAID group and 5.4 ± 4.1 mmHg in the control group (p = 0.049). Relative IOP reduction was 17.5% ± 13.0% and 21.8% ± 14.8% in the NSAID and control groups, respectively (p = 0.033). The same tendency of superior results in control eyes compared with NSAID eyes was seen in an extensive subgroup analysis. A multiple linear regression analysis confirmed NSAID treatment as a negative predictor of IOP reduction after adjustment for covariates (p = 0.023). Survival analysis showed a longer median time to treatment escalation in the control group, though not statistically significant. Conclusion: Topical NSAID treatment was not associated with an increased SLT efficacy. On the contrary, the present study is the first to demonstrate that SLT effectiveness may even be reduced by NSAIDs. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to compare the monocular Humphrey Visual Field (HVF) with the binocular Humphrey Esterman Visual Field (HEVF) for determining whether subjects suffering from glaucoma fulfilled the new medical requirements for possession of a Swedish driver’s license. Methods HVF SITA Fast 24–2 full threshold (monocularly) and HEVF (binocularly) were performed consecutively on the same day on 40 subjects with glaucomatous damage of varying degrees in both eyes. Assessment of results was constituted as either “pass” or “fail”, according to the new medical requirements put into effect September 1, 2010 by the Swedish Transport Agency. Results Forty subjects were recruited and participated in the study. Sixteen subjects passed both tests, and sixteen subjects failed both tests. Eight subjects passed the HEFV but failed the HVF. There was a significant difference between HEVF and HVF (χ2, p = 0.004). There were no subjects who passed the HVF, but failed the HEVF. Conclusions The monocular visual field test (HVF) gave more specific information about the location and depth of the defects, and therefore is the overwhelming method of choice for use in diagnostics. The binocular visual field test (HEVF) seems not be as efficient as the HVF in finding visual field defects in glaucoma subjects, and is therefore doubtful in evaluating visual capabilities in traffic situations.